Provider Demographics
NPI:1194221689
Name:WILSON, THOMAS LAWRENCE
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:LAWRENCE
Last Name:WILSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ONE MEDICAL CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27157-1029
Mailing Address - Country:US
Mailing Address - Phone:336-716-4081
Mailing Address - Fax:336-716-3065
Practice Address - Street 1:ONE MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-1029
Practice Address - Country:US
Practice Address - Phone:336-716-4081
Practice Address - Fax:336-716-3065
Is Sole Proprietor?:No
Enumeration Date:2018-04-03
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program